Mejia Alejandro, Vivian Elaina, Shah Jimmy, Barrera Gutierrez Juan Carlos
Surgery, The Liver Institute, Methodist Dallas Medical Center, Dallas, USA.
Performance Improvement, Methodist Dallas Medical Center, Dallas, USA.
Cureus. 2023 Dec 22;15(12):e50949. doi: 10.7759/cureus.50949. eCollection 2023 Dec.
Background Pancreatic ductal adenocarcinoma (PDAC) is the most common type of pancreatic cancer (PC) in the United States. In patients with resectable PC, identification of pretreatment biomarkers before surgery can help in the decision-making process by weighing the benefits of neo-adjuvant therapy, surgical procedure, and adjuvant therapy. The purpose of this study was to determine if the albumin-bilirubin (ALBI) score and immune-inflammatory marker levels can be used in combination as pretreatment predictors of mortality risk in patients undergoing the Whipple procedure (alternatively, pancreatoduodenectomy (PD)) for PDAC. Methods This retrospective study included 115 patients with PDAC who underwent open or robotic Whipple procedures between January 2013 and December 2022 at a single tertiary medical center. Logistic regression analysis was used to find the association between predictors and mortality. Machine learning algorithms were used to calculate the performance of the different models. Results Bivariate analysis showed that the variables "sex" and "body mass index (BMI)" had a potential association with mortality, although statistical significance was not achieved for sex (p = 0.07). Patients with BMIs >25 kg/m had a higher risk of mortality compared to patients with BMIs ≤24.9 kg/m (odds ratio (OR) = 2.2, 95% CI = 1.03-4.8, p = 0.04). Higher (more positive) ALBI scores (>-2.24) were also associated with increased mortality risk (OR = 4.6, 95% CI = 2-10.5, p = 0.0003). When the cutoff values of the inflammatory markers were used to categorize these variables, values greater than the cutoff values were associated with an increased risk of mortality. In the multivariate logistic regression model, an ALBI score >-2.24 (OR = 4.3, 95% CI = 1.8-10.3, p = 0.0008), neutrophil-to-lymphocyte ratio (NLR) >3.5 (OR = 3.3, 95% CI = 1.4-7.9, p = 0.007), and being a woman (OR = 2.6, 95% CI = 1.1-6.4, p = 0.03) remained influential predictors of increased mortality (c value = 0.77). Conclusion The ALBI score and the NLR are easily accessible markers; their use, combined with a patient's sex, can provide useful pre-surgical information regarding mortality risk after PD. This can aid in treatment planning as well as expedite decisions about the type of Whipple procedure, adjuvant therapy, and surveillance, which can subsequently improve a patient's outcomes and survival.
背景 胰腺导管腺癌（PDAC）是美国最常见的胰腺癌（PC）类型。在可切除性PC患者中，术前识别预处理生物标志物有助于通过权衡新辅助治疗、手术程序和辅助治疗的益处来辅助决策过程。本研究的目的是确定白蛋白-胆红素（ALBI）评分和免疫炎症标志物水平是否可联合用作接受胰十二指肠切除术（Whipple手术，又称胰头十二指肠切除术（PD））治疗PDAC患者的术前死亡风险预测指标。方法 这项回顾性研究纳入了2013年1月至2022年12月期间在一家三级医疗中心接受开放或机器人辅助Whipple手术的115例PDAC患者。采用逻辑回归分析来寻找预测指标与死亡率之间的关联。使用机器学习算法计算不同模型的性能。结果 双变量分析显示，“性别”和“体重指数（BMI）”变量与死亡率存在潜在关联，尽管性别未达到统计学显著性（p = 0.07）。BMI>25 kg/m²的患者与BMI≤24.9 kg/m²的患者相比，死亡风险更高（比值比（OR）= 2.2，95%置信区间（CI）= 1.03 - 4.8，p = 0.04）。较高（更正向）的ALBI评分（>-2.24）也与死亡风险增加相关（OR = 4.6，95% CI = 2 - 10.5，p = 0.0003）。当使用炎症标志物的临界值对这些变量进行分类时，大于临界值的值与死亡风险增加相关。在多变量逻辑回归模型中，ALBI评分>-2.24（OR = 4.3，95% CI = 1.8 - 10.3，p = 0.0008）、中性粒细胞与淋巴细胞比值（NLR）>3.5（OR = 3.3，95% CI = 1.4 - 7.9，p = 0.007）以及女性（OR = 2.6，95% CI = 1.1 - 6.4，p = 0.03）仍然是死亡风险增加的有影响力的预测指标（c值 = 0.77）。结论 ALBI评分和NLR是易于获取的标志物；将它们与患者性别结合使用，可以提供关于PD术后死亡风险的有用术前信息。这有助于治疗规划，并加快关于Whipple手术类型、辅助治疗和监测的决策，从而改善患者的预后和生存。
